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Tuesday, September 19th 2006

Charity Hospital

I’m Not So Sure The Tipping Point Applies Here

I was in New Orleans recently for a conference and took a tour of the condemned Charity Hospital.

The oldest continuously operating hospital in America (not in its current rendition/building obviously), was founded in 1736 by a French sailor and lived through all the horrors the world could throw at it for more than 250 years before Katrina. Its history might not always have been pretty (the history of healthcare isn’t always).

In 1815 someone wrote, upon visiting Charity Hospital, that it “served no purpose than to confine the wretched and compel them to die in a place contrary to their choice.” Patients were found abandoned. Chickens wandered in, and their shit covered the furniture. The mattresses on which the patients slept were filthy with “the visible marks of the putrid discharges of those who had died on them of the most pestilential diseases.”

But the idea of Charity Hospital was a thing to behold I imagine. For all those years it served no other purpose but to care for those from New Orleans with no other options.

Charity was the busiest emergency department in New Orleans. Its care for the indigent helped allow other hospitals in the area, such as Oshner, to have just 3% of their patients without insurance (half the national average).

And then came Katrina.

The inside of the hospital is a wreck, as can be imagined. Words on walls informing whomever it might’ve concerned that there were bodies in a certain stairwell. Abandoned euiptment. The lights on half the floors still unable to be powered, a year after the basement flooded and winds tore apart windows. Dark, even during the day.

Like you saw all over New Orleans during the rescue effort, markings on all the hospitals doors signify where rescurers came through (so they wouldn’t waste effort checking rooms more than once). What is stunning is all the ruined euiptment (which is state property) which cannot be moved out for state accounting bueacracy. Better not let those musty soaked boxes of latex gloves get lost…they’re on some roll in Baton Rouge!

More than 200 patients and hundreds upon hundreds of staff trapped without food or lights or air conditioning or the power to fuel IV pumps or vents. Or help.

About 2,200 people were evacuated, including 363 patients. Some were taken out on stretchers and others on piggyback.

Three terminally ill patients died during the evacuation. Smithburg did not know how many died waiting for help.

At Charity, the largest public hospital and trauma center in the city, gunshots on Thursday had prevented efforts to evacuate more than 250 patients.

Earlier in the day, the hospital’s morgue had 12 bodies, and another five were stacked in a stairwell — in both cases under water. Other bodies were in other parts of the hospital

It was moving to get to put a place (even a year later) to these words from Thursday, the day before Charity and University Hospitals were finally reached.

The phones were dead, the halls were dark and the heat unbearable. Desperately ill patients who needed oxygen were being kept alive by a rotation of health workers pumping air into their lungs using bladders called ambu-bags.

“Somebody needs to come in a hurry,” says Norman McSwain, director of trauma surgery at Charity. “By ‘in a hurry,’ I don’t mean tomorrow or the next day. They need to get here tonight.

“By tomorrow, we’ll have dead patients simply because they were not evacuated.”

Charity is part of the Medical Center of Louisiana which includes University Hopsital.

An LSU neonatologist was at University Hospital during the storm and came and gave a presentation on his experience. When the leeves finally broke and the basement (including the hospitals generators) flooded, he had multiple kids on HFOV. He had to evacuate them and he called state offices over and over trying to get a boat out to Charity. Without luck. Finally, he called a colleague, on a cell phone that was running out of power, at a hospital which hadn’t been overrun by the flood waters. He asked him to get a fire truck to a nearby unflooded intersection and to get a boat to come out to the hospital.

He goes down and checks the front of the hospital often that afternoon. Hour after hour. And of course he can’t be sure when, much less, if someone will show up to take these kids. Finally, one visit down from the NICU he spots a three guys in scrubs floating by in a canoe.

Turns out an ortho resident had the foresight to bring a canoe up to the hospital before Katrina. Trust three orthopaedic residents with a very sick infant…a lovely thought. But he doesn’t really have a choice so the neonatologist hands the kid over to the three and tells them see this tube? it needs to stay in place; squeeze the bag, make sure the chest rises and the kid stays pink. A crash course in bagging this infant and away they go to look for this fire truck.

They find it and the neonatologists’ colleague is there – a fifteen year veteran of the NICU. The ortho resident hands the little baby over and the first thing he says is,

“See this tube? It needs to stay in place. Squeeze the bag, make sure the chest rises and the kid stays pink.”

Its funny now but only because the neonate made it. I don’t know what I would’ve done over those days and days if I had been that doctor. Cramped up with all those sick babies without the resources to care for them or, even really maintain my composure and clear head. The trip through the empty halls really made you think.

JAMA published a poem on the closure of Charity
a while back. It reads on the loss of Charity as a place of teaching, from a doctor who trained there. It reads in part, that despite Charity’s dissappearance,

Our hands remember though
how to wield a knife,
separate good tissue from bad,
preserve vessel and nerve
and something more—
how to touch a dying patient
whisper a wordless benediction
and receive a blessing in return.

I suppose Charity is just one more part of herself that New Orleans lost. Time tell how much of such is recovered. There is however a push to renovate Charity (no small task from what these eyes have seen). Although judging from the internet chatter (or lack thereof) the move to Save Charity Hospital may have died down a little bit.

Governor Kathleen Blanco pledged to help in the renovation of Charity Hospital as a campaign promise when she ran for Governor. Yet, she has gone back on her word and is now supporting closing down Charity Hospital in order to build a new hospital. Why? The situation facing New Orleans residents today is critical. Why wait for years to see that a new hospital is built instead of beginning renovations today of a hospital already in place?

Over 70% of the doctors who practice medicine in the State of Louisiana trained at Charity Hospital. Without Charity how will the State insure a constant stream of new physicians to replace those lost as a result of Hurricane Katrina and those lost to retirement? Doctors from other states are not “beating down the door” to practice medicine in the State of Louisiana.